Heroin Abuse in the United StatesBy Joan F. Epstein and Joseph C. Gfroerer

Numerous reports have suggested a rise in heroin use in recent years, which has been attributed to young people who are smoking or sniffing rather than injecting. The purity of heroin has increased to a level that makes smoking and sniffing feasible. The increased purity and concern about AIDS may be causing the shift from injecting to smoking and sniffing among heroin users. This paper examines these issues in addition to examining the prevalence of heroin use. It also describes the characteristics of heroin users and trends in heroin use.

The data presented here come from a variety of sources. One source is the Community Epidemiology Work Group (CEWG), a network of researchers from major metropolitan areas of the United States and selected foreign countries who meet semiannually to discuss the current epidemiology of drug abuse.1 It provides ongoing community level surveillance of drug abuse though the collection and analysis of epidemiologic and ethnographic research data. Another source is “Pulse Check”, a series of qualitative interviews with ethnographers, treatment professionals and law enforcement agencies which provide a quick and subjective picture of what is happening in drug abuse across the country.2 The heroin retail price/purity system is a statistical system using information gathered by the Drug Enforcement Administration. Purchases and seizures meeting certain retail level criteria ranges are averaged each quarter to produce a national retail purity figure and a retail price figure.3 A computerized data base program is used to record, collate, and display the results of qualitative and quantitative chemical analysis of all drug evidence submitted to the Drug Enforcement Administration Lab. Purity data are based on printouts of average purities for the 1-to-10 gram, 1-to-10 ounce, and 1-to-10 kilogram ranges.5

The Drug Abuse Warning Network (DAWN) consists of two data collection efforts: data on drug abuse deaths reported by medical examiners in participating metropolitan areas and data collected on drug-related visits to a national probability sample of hospital emergency departments.5, 6 Data on client admissions to specialty substance abuse treatment programs are obtained from the Treatment Episode Data Set (TEDS).7 TEDS, which is compiled by SAMHSA from reports from states, covers primarily publicly-funded treatment facilities and accounts for about half of all public and private admissions to treatment in the U.S. All states do not participate. The National Household Survey on Drug Abuse (NHSDA) is an ongoing national probability survey that provides information on the use of illicit drugs, alcohol, and tobacco in the civilian noninstitutionalized population of the U.S., 12 years old and older.8 Monitoring the Future (MTF) is an annual survey by the University of Michigan’s Institute for Social Research under a grant from the National Institute on Drug Abuse (NIDA).9 Since 1975, it has surveyed a representative sample of all seniors in public and private schools in the coterminous United States. In 1991 MTF was expanded to include annual surveys of eighth and tenth graders.